A Mayo Clinic employee—part of the Joint Trauma System Team—was recently honored with the newly created Military Health System (MHS) Battlefield Innovation Award for exceptional work in combat care over the last 10 years. The MHS created this award to recognize an initiative that has improved the way the combat care unit treats injured U.S. soldiers on the battlefield. Work most currently being undertaken by that group involves work inspired right here at Mayo Clinic.
About the Military Health System
On the battlefield, the MHS comes together to save the lives of U.S. soldiers. It brings together Army, Navy, Marines, and Air Force medical professionals and ensures that those in uniform are medically ready to deploy anywhere around the globe on a moment's notice. It also ensures that there are medical professionals ready to travel with the deployed soldiers. There isn’t another military medical force like it in the world.
The MHS does so much more than combat medicine. It’s a complex system that provides medical education and cutting-edge research and development.
About Combat Care
Combat Care is a section of the MHS that treats injured military men and woman oversees in the midst of combat. Combat Care takes place in medical tents in the middle of dangerous combat zones where specialists and complex medical equipment are not readily available.
In past years, the military hospitals in combat zones have worked as independent entities and did not communicate to each other when assistance was needed. Each branch of the military had its own facilities where medical personnel would treat combatants of their respective branches. This would cause issues if a specialist or blood products were not available at a branch hospital where an injured combatant was being treated.
Bringing a System of Care Overseas
The Joint Trauma System efforts started in 2004 when Donald Jenkins, M.D., Consultant in the Trauma/Critical Care Center, worked as an Air Force surgeon stationed in Balad, an air evacuation hub between Baghdad and Fallujah, Iraq. Dr. Jenkins saw firsthand that the lack of a care system was allowing preventative health issues to go untreated, and he knew that there was a better way to treat the injured soldiers.
Dr. Jenkins had been in communication with surgeons working in a San Antonio, Texas, hospital and trauma system, and together, they shared a model of care idea with the military system in Iraq. The model of care would open up communication among the branch hospitals in order to better care for the soldiers. After implementing the care system, injured soldiers in need of treatment were now routed to the closest capable hospital instead of being transported to their specific branch hospital, which could be located miles away. At one point in time, the team was able to perform 450 major life-saving operations within 10 days in a three-tent hospital, proving that the new system was effective.
Soon after the success in Fallujah, Dr. Jenkins was asked to create a trauma system in Baghdad across all of Iraq for the Army Medical Command. Six nurses were sent to join the team, and the center/system was operational within a month. The team wrote guidelines, protocols, and created a database to capture injuries that were seen in the hospitals. They also captured treatments and outcomes of the injuries that could help prevent the same preventable issues from reoccurring. This data is still being collected and reviewed by Dr. Jenkins and the Department of Defense Trauma System in San Antonio, and new protocols are being added as new challenges arise.
Transfusion Medicine Laboratory Paving the Way
The great success of implementing a care system within the Military Health System brought an opportunity for the Department of Laboratory Medicine and Pathology to share its research in pre-hospital blood transfusions during trauma. The military had been watching Mayo’s initiatives to better care for trauma patients in the civilian world and was interested in adopting Mayo’s practices in combat zones.
Mayo Clinic was the first civilian trauma service to carry and transfuse thawed plasma on an air ambulance and one of the first civilian trauma centers (along with the University of Pittsburgh) to re-adopt the use of stored whole blood in trauma resuscitations.
The use of O stored whole blood (SWB) was regularly used in the military during the mid-20th century but had changed due to AABB standards that require ABO group-specific whole blood to be used during transfusions.
Approval was required from the FDA and AABB to move forward with the SWB implementation, so the Transfusion Medicine Laboratory and Mayo Clinic Laboratory Compliance Office submitted a variance with the AABB to allow group O platelet-preserved leukocyte-reduced whole blood to be used in transfusions. The variance was approved, and a practice management guideline was created, allowing Mayo to move forward with the initiative. The variance paved the way for others wanting to use cold-stored platelets, if they chose. Mayo Clinic became the first trauma center in the United States to use cold-stored platelets in trauma resuscitations and the military is looking to follow Mayo’s lead.
A paper entitled, “How we provide thawed plasma for trauma patients,” co-authored by James Stubbs, M.D., was published in the journal Transfusion, describing the research and steps involved to implement this first-of-its kind initiative.